Two hospitals with private finance initiative projects are preparing to cut hundreds of jobs.
University Hospitals Coventry and Warwickshire trust is planning to make 200 non-clinical staff redundant in the next six months as part of a drive to save£30m by the end of the financial year.
The trust - which opened a new PFI hospital in Coventry last year - said it had identified£20m of savings through more efficient working and negotiating on the price of supplies, but was still£10m short.
Interim chief executive Martin Lee said: 'It is clear that, with the exception of cutting services, the only major area left within which to make significant savings towards the£10m is post reduction.
'We will be looking primarily to reduce managerial, corporate and administrative jobs. Wherever possible we will be looking for voluntary redundancies. However, we may need to consider compulsory redundancies as well.'
The trust has to make repayments of£56m a year on its hospital, which cost£400m to build.
Portsmouth Hospitals trust plans to reduce its 7,000 staff by 750 full-time posts over the next four years, as set out in its PFI business case.
The trust will face a£43m-a-year bill for its PFI-funded redevelopment from 2009 - increasing its cost base by£27m.
It is planning to make efficiency savings when services are centralised on one site, rather than three. The trust said it hopes to reduce the posts through natural wastage.
Overall, it aims to make£40m annual savings to cover this and other cost increases. Its annual budget is around£400m.
Finance director Neil Kemsley said: 'This is about us managing our financial health rather than any kind of recovery or turnaround.'
Unison's South East regional organiser Mike Wilson said the job losses were the consequence of paying for healthcare on the 'never, never'.
He said: 'It is the worst example of buy now, pay later - PFI has been a bad deal and it will cost jobs.'